We have created this form to improve patient convenience and access to contraceptive or HRT medication.

Patients under 18 need a face-to-face appointment and should contact the medical centre directly.

Please complete this form in full so it can be reviewed by the clinical team.

It is very important that we have an up-to-date height, weight and blood pressure reading before we can issue a prescription.

If this information is not provided, a prescription may not be issued as these details are required for safe prescribing.